Healthcare Provider Details

I. General information

NPI: 1255087177
Provider Name (Legal Business Name): JENNIFER DALIT BACANI LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER RONA DALIT BACANI

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23710 EL TORO RD # 1084
EL TORO CA
92630-4711
US

IV. Provider business mailing address

23710 EL TORO RD # 1084
EL TORO CA
92630-4711
US

V. Phone/Fax

Practice location:
  • Phone: 949-682-5366
  • Fax:
Mailing address:
  • Phone: 949-991-5366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: